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Valdes Lupi: Nation needs to make long-term investment in public health and prevention


What will public health look like in 2030? In June 2014, The Kresge Foundation partnered with the Robert Wood Johnson Foundation and the Institute for Alternative Futures to tackle that question in a report, Public Health 2030: A Scenario Exploration. This report offered four alternative scenarios for the future of public health and a series of recommendations for ensuring agencies that work to control communicable diseases, ensure food safety, promote health, and foster emergency preparedness and response, were able to fulfill their mission.

At the time the Public Health 2030 report was issued, I was serving as the deputy commissioner at the Massachusetts Department of Public Health. Although the economic downturn caused by the Great Recession occurred in 2007-2009, many public health agencies had never been able to fully recover from draconian budget cuts. Nationally, the aftermath of the recession resulted in the loss of an estimated 19% of government public health workforce positions, which is roughly 51,000 jobs in state, territorial and local public health departments. The lack of investments in public health leading up to the Great Recession made our work even more challenging in addressing population health since unemployment, the foreclosure crisis, and the increasing wealth gap all contributed to worsening health outcomes – particularly for people with low incomes and communities of color.

The future for public health is here now. An infusion of one-time stimulus and emergency funding from our federal government will go far in building capacity at all levels of public health to expand the workforce, improve and modernize data systems and surveillance and enhance epidemiology and laboratory capacity. But we need to do more.

The American Rescue Plan of 2021 will invest billions of dollars in rebuilding and expanding critically important public health infrastructure. Most importantly, with the Biden administration’s whole government approach for tackling racism head on and integrating health equity across all the cabinet agencies, we have a unique opportunity to reimagine the future of the public health system. There is already a framework that we can use to shore up our public health system and meet the challenges of the 21st century. This framework, “Public Health 3.0,” involves advancing data modernization, cross-sectional partnerships, foundational public health capabilities and a diverse and inclusive workforce. The 100 local health leaders who are participating in Kresge’s Emerging Leaders in Public Health Initiative (ELPH) are strengthening their ability to serve as chief health strategists and implementing transformative initiatives that meet the goals of this framework. They have successfully launched efforts that ground their public health efforts with a racial justice lens, engage other sectors and agencies to advance health equity, and formalize the ways in which communities are driving public health programming and services.

We are actively exploring ways to redesign and launch an updated ELPH initiative to adapt to the changing conditions on the ground. With an increasingly demanding workload and rapidly rising turnover rates among our health directors, the time for action is now. This is why we have joined our colleagues at the American Public Health Association and the Alliance for Disease Prevention and Response to support the opportunity for everyone to be healthy and to ensure we have the necessary, comprehensive infrastructure to protect us from COVID-19 and all future diseases and health challenges.

We must not waste these opportunities to advocate for sustainable, long-term investments in public health. All sectors have a role in stopping COVID-19, but beyond the pandemic, we need to double down on our work together to reduce inequities, engage underserved communities, and advocate to ensure sufficient levels of funding for public health and prevention. Together, we must seize the chance to build bridges to better health and ensure that no communities are left behind.